The Effects of a 12-Week Home-Based Adapted Physical Activity Intervention on Health-Related Physical Fitness in Adult Women with Fibromyalgia Syndrome: An Interventional Field Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the paper " The effects of a 12-week Home-Based Adapted Physical Activity Intervention on Health-Related Physical Fitness in Adult Women with Fibromyalgia Syndrome "

Congratulations on the opportunity to study this very specific and often overlooked medical condition.

To make it easier for the reviewers, I will go through the text section by section.

Abstract

There is an inconsistency in sample demographics, the participants were "43.9 ± 12.2 yrs," which corresponds to the control group's age (reported in the Methods), not the full sample.

The study’s conclusions could be improved, as they are speculative and are not directly supported by the results.

The keywords should not include words that are already in the title could you please amend them?

Introduction 

Reference 4 (Busch et al.) is incomplete, it appears as an author list with no title, journal, year, volume or pages. 

The sentence "APA has been proposed as the basis for the treatment of FS [2, 9, 10]" is a strong claim. The cited EULAR guidelines (ref. 9) recommend exercise broadly, not specifically APA. Please verify the accuracy.

What is ‘fibrofog’ (line 68)? Could you explain?

 Materials and Methods

The study is described as a "longitudinal study" but it is, more precisely, a randomised controlled trial (RCT). Could you explain?

There is no mention of pre-registration (e.g., ClinicalTrials.gov). For an RCT, this is strongly recommended by most journals and should be disclosed if applicable. Could you explain?

Randomisation method is not described. Could you explain?

Could you please explain in more detail the rationale behind carrying out three assessments, particularly at the three-month mark?

Sample size justification is absent. No power calculation is provided. Could you explain?

Were control group participants given any instructions? It is very important that this point is clearly stated

No statistical test for baseline equivalence is reported.  Age may be a confounding variable?

Results 

In the text (line 186), the time × group interaction for upper-body strength is reported as p = 0.001, but in Table 2 the same result appears as p < .001 for agility and p = .001 for arm curl, this appears consistent but should be double-checked for accuracy.

 Discussion 

Reference 30 (Loftus et al.) is cited for improvements in the 6-minute walking test, but this is not a direct comparator for the 2-minute step test used in this study. The equivalence of these measures should be acknowledged.

The discussion of limitations (lines 277–290) not mention, a lack of blinding of assessors or participants; the absence of a power calculation; the psychosocial component embedded in the cool-down discussion; the potential confounding effect of age difference between groups and the generalisability of findings given the exclusively female, university-affiliated sample.

Conclusions 

The conclusion should directly address the stated objectives. Could you rephrase that?

 

Reference 16 has a duplicated number prefix ("16. 16.")

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this article. The aim of the authors was to evaluate the effects of a home-based adapted physical activity program, on physical fitness of women with fibromyalgia.

I would like to congratulate the authors on their work; the topic is interesting and somewhat innovative.

Here are my comments:

• Page 1, Abstract, Background, line 21: Given that the first studies testing Adapted Physical Activity (APA) in people with fibromyalgia date back to 2015 (e.g., 10.3233/BMR-140497) I invite the authors to remove the term “innovative”
• Page 1, Abstract, Methods: I suggest that the authors also specify in this section that the duration of the intervention is 12 weeks, as the 6-week assessment might confuse the reader.
• Page 2, Introduction, line 47: The authors refer to “several treatment options” without listing them in the text. I encourage them to include this information.
• Page 2, Introduction, line 52: The authors introduce the concept of APA without specifically describing what it entails or who it is intended for. I invite them to add this information.
• Page 2, Introduction, line 69: The authors refer to the concept of “fibrofog” without describing it. Given that this is a peculiar aspect of the disease, I encourage them to add some information on the topic.
• Page 3, Materials and Methods, Participants: Can the authors explain why, at the end of randomization, the two groups did not have similar sample sizes? (intervention group 17, control group 12, instead of 15 and 14)
• Page 4, Materials and Methods, Training protocol, lines 152-153: How were flare-ups managed during the load progression? I suggest that the authors clarify this important detail.
• Page 4, Materials and Methods, Outcome measures: Given that the training sessions were conducted online, where, when, and by whom were the tests administered?
• Page 4, Materials and Methods, Outcome measures: I suggest that the authors include a brief description of the tests performed.
• Page 4, Results: Given that adherence to the program is a crucial issue, especially in home-based exercise programs, did the authors collect data on the percentage of training sessions that were completed?
• Page 4, Results, Table 1: I encourage authors to add a legend and to verify that the units of measurement are correct.
• Page 6, Discussion, lines 226-227: The authors rightly point out that improving physical fitness can enhance patients’ overall well-being. However, this study did not include any measures of this aspect. I suggest addressing this gap in the limitations section.
• Page 6, Discussion: In the limitations section, I suggest that the authors mention that individuals with limited technological skills are excluded from this type of intervention.
• Page 8, References: I ask the authors to review and correct reference number 4.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript entitled “The effects of a 12-week Home-Based Adapted Physical Activity Intervention on Health-Related Physical Fitness in Adult Women with Fibromyalgia Syndrome” was reviewed. The article provides interesting information on the topic; however, adjustments need to be made so that the article can continue the path to publication. I kindly ask if all changes made to the text be highlighted in yellow or a different color in the text.

 

Below are the reviewer's considerations to be adjusted in the manuscript.

 

Title:
1- Present the main statistical analysis in the title, as well as the type of study.

 

Abstract:

2- Please make the background more objective so that you can invest in writing the results.

3- Present a specific topic for the objectives.

4- In the results, please present in more detail the quantitative information of the participants in relation to the groups and time.

5- In the conclusions you mention association, however, in the methodology and results of the abstract, no association tests are observed. Please be more assertive in answering the objectives in relation to what was analyzed.

 

Keywords:

6- Do not repeat words already mentioned in the title; please replace them with synonyms.

 

Introduction:

7- Begin the introduction by presenting global epidemiological information on the disease, how many people are affected annually, and how many there are.

8- The paragraph sizes are disproportionate; please merge paragraphs so that they are all of similar size.

9- Mention in the introduction the pathophysiology of the disease and the mechanisms by which physical exercise promotes improvements in patients. Compare the effects of exercise with medications.

10- Make clearer the current state of the art on the subject and how the present study can contribute to the evolution of the area.

11- After mentioning the objectives of the study at the end of the introduction, present the main hypotheses of the research.

 

Materials and Methods:

12- At the beginning of the methodology, please state the type of study. If it is a clinical trial, what type is it: randomized, placebo-controlled? This information should be included in the research title.

13- For your type of study, it is necessary to present the CONSORT 2025 Flow Diagram. This allows you to know how many people were invited, how many were excluded, and what the randomization criteria were.

14- You also need to present, as supplementary material, the CONSORT 2025 expanded checklist of detailed information to include when reporting a randomized trial.

15- In the case of your study, it is necessary to register the study as a clinical trial. All these items are essential for the article to be published.

16- Mention where the data collection was carried out, for example, city, state, country, and the sociodemographic information of the location.

17- Participant information should not be presented in the methodology and at the beginning of the results.

18- Take the opportunity to specifically describe all the tests and assessments performed, as well as the technical information of the equipment used.

19- Provide a separate section on the inclusion and exclusion criteria of the study. Detail these criteria better, because age between 30 and 65 years. Note that they mixed young adults and almost elderly people. Regarding medication and time of diagnosis, were these not used as criteria? And the intensity of pain?

20- Explain better how the participants were selected and how the randomization process was carried out.

21- Please provide a graphic explaining the logistics of the study in relation to data collection and interventions.

22- Since the training was online without in-person supervision, how could you be sure that people were performing the activities correctly? This is a major limitation of the study.

23- Describe the physical tests better so that readers can replicate the information, if necessary.

 

Results:

24- Begin writing the results with the sociodemographic, anthropometric, and body composition information of the participants.

25- Present all abbreviations in the table and figure captions. For example, what do groups C and E mean? What are T0, T1, and T2?

26- To make the text more didactic, replace Table 1 with a figure. This way, you can present the main information in text before the figure. What type of statistical analysis was performed in Table 1? Please describe it in the caption.

27- The information in Table 2 should be presented before the information in Table 1, as it guides the reader.

28- My suggestion is that you enrich the study with association and correlation tests to identify the variables. Present the analyses as figures and tables.

 

Discussion:

29- The discussion should be used to answer and explain the results, not to present results again; please adjust accordingly.

30- Try to explain the findings based on clinical studies and seek to explain physiological effects to justify the evolutionary issues of the patients.

31- I didn't understand why you work with fibromyalgia and don't evaluate the effects of the exercise program on patient pain. I believe this is a significant limitation, since this is the patients' biggest complaint.

32- Regarding the limitations, you should make major adjustments following what was raised by the reviewer.

33- Address the clinical applications of the study at the end of the discussion.

 

Conclusions:

34- In conclusions, please be more assertive in answering the objectives of the study.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review the paper once again. Having reviewed the revisions and noted that significant changes have been made which have greatly improved the paper, I would like to congratulate the authors. I agree with the changes made and with all the improvements that have been implemented.

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors,

Thank you for providing the revised version of the manuscript. After critical analysis, significant improvements were noted in the material. Therefore, my suggestion is that it be accepted for publication.